Five Questions Republicans Can’t Answer About Their Obamacare Replacement

MOST POPULAR

House Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) did something extremely cruel to their rank-and-file Republican members last week: They sent them home for a week-long recess defenseless in addressing constituents’ growing fears about losing their Obamacare and Medicaid coverage.

Ryan, the GOP leadership’s top policy guru, and McConnell, the wily strategist, sought to rally their members late last week on the need to “save” Americans from the collapse of the Affordable Care Act – including rising premiums and declining policy choices as Humana and other major insurers announce their intentions to drop out of the market in the coming year because of huge financial losses.

Ryan told his members that he and other GOP leaders were closing in on a plan to repeal much of the Affordable Care Act and replace it with a series of dramatic changes, including a refundable tax credit to help consumers cover premium costs, increased availability of tax-exempt health savings accounts, and a revamping of the Medicaid program for low-income Americans.

The House GOP approach – loosely spelled out in a thin booklet of talking points -- would preserve a number of features of the existing Obamacare law, including preventing insurers from discriminating against applicants with pre-existing medical problems and allowing children to remain on their parents’ private health care plans until they turn 26. And the Republicans would experiment with federally financed, state-run “high-risk pools” to provide coverage to older and sicker Americans who can’t find affordable health insurance in the private market.

But the disparate talking points lack a coherent framework. And critics say they raise more questions than they answer. Without the benefit of a hard-boiled analysis and scoring by the Congressional Budget Office and the Joint Committee on Taxation – that probably won’t be available until members return from recess -- there is virtually no way to know what the unfolding GOP Obamacare replacement plan adds up to.

What’s more, the House GOP plan is just one of a handful of plans making the rounds on Capitol Hill. And President Trump has promised to unveil the details of a plan of his own next month.

That may help to explain why many GOP lawmakers have been set back on their heels by probing questions now being posed by Republican and Democratic constituents alike about the future of the health care system if Trump and GOP leaders make good on their campaign pledge to “repeal and replace” Obamacare.

MoveOn.org and other liberal groups are mobilizing members to attend town-hall meetings across the country, The New York Timesreported, and MoveOn has created a website, ResistanceRecess.com, to help people find the meetings. The site also includes a guide to “health care messaging.” Not all of these attendees benefit from Obamacare if any. Their goal is to disrupt the meetings and leave the impression that most of their constituents want the government to continue funding Obamacare.

In recent days, Reps. Jason Chaffetz of Utah, Mark Sanford of South Carolina and Tom McClintock of California have been swamped by irate constituents voicing fear and outrage over the possibility they may lose their health insurance, while other Republicans have ducked scheduled town hall meetings, fearing violent confrontations. Just yesterday, Sen. Chuck Grassley of Iowa was swamped with questions as well at two town hall meetings in Iowa.

During one of those meetings at the Iowa Falls community center, Chris Petersen, 62, a pig farmer and self-described progressive Democrat who suffers from diabetes, told Grassley he frets about losing his health insurance, according to Politico.

“If it wasn’t for Obamacare, we wouldn’t be able to afford insurance,” Petersen said. “Over 20 million will lose coverage, and with all due respect, sir, you’re the man who talked about the death panels [in opposing enactment of Obamacare in 2009]. You’re going to create one great big death panel in this country for people who can’t afford to get insurance.”

Grassley sought to reassure the crowd by saying that there were three or four main GOP health care plans being circulated in Congress that would preserve the most popular features of Obamacare. He ventured to speculate that under any of those alternative GOP plans, the 20 million people currently covered by Obamacare won’t lose their coverage.

But without the CBO and Joint Committee on Taxation scoring any of those plans, it’s virtually impossible to assess their impact. What’s more, there’s no way of knowing for sure how much of their replacement plan Republicans will be able to enact under the expedited budget reconciliation budget rules they intend to employ this spring or summer to repeal the heart of Obamacare’s mandates and regulations.

“The House Republican talking points begin by indicting the ACA’s health insurance marketplaces and Medicaid in an attempt to justify rushing to repeal the former and radically overhaul the latter,” the liberal-leaning Center for Budget and Policy Priorities said in a report last week. “But in fact, these programs are providing affordable, quality health insurance for tens of millions of Americans, and the ACA has improved coverage for tens of millions more. Dismantling the ACA and restructuring and cutting Medicaid will only worsen health care access, quality, and affordability, the standards by which any health care legislation should be judged.”

Here are five questions the Republicans can’t currently answer:

Will the more than 8 million Americans currently holding Obamacare health care coverage and an additional 10 million who qualify for expanded Medicaid still have coverage a year from now when the new Republican plan is phased in? If not, how many will be dropped from the rolls?

If someone is currently on either the traditional or expanded Medicaid program for low-income or disabled people, will he or she still have coverage once the Republicans cut and overhaul the programs and turn them into per capita payments or block grants to the states?

Will consumers currently using Obamacare have to pay more in premiums and out-of-pocket costs their health care under the new system?

What about sick and elderly people who currently are guaranteed health care coverage under Obamacare? What happens if they get shunted into federally funded, state-operated “high risk” pools as envisioned by the Republicans? If Congress subsequently cuts back funding for the risk pool, will the elderly be out of luck?

Washington Editor and D.C. Bureau Chief Eric Pianin is a veteran journalist who has covered the federal government, congressional budget and tax issues, and national politics. He spent over 25 years at The Washington Post.